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REPLY

Do Lipid-Lowering Agents Provide a Greater Reduction in Cardiovascular Events among Patients with Diabetes?

right arrow Ned Calonge, MD, MPH, and Diana Petitti, MD, MPH

2 December 2008 | Volume 149 Issue 11 | Pages 841-842


IN RESPONSE:

In making its recommendation on screening for type 2 diabetes, the USPSTF considered interventions, including lipid-lowering agents, for effects on such health outcomes as cardiovascular events. In reviewing the evidence on lipid-lowering agents, the USPSTF found that persons with diabetes do not seem to benefit to a greater extent than those without for the primary prevention of cardiovascular events, whether considering absolute or relative risk reduction. For example, in the Heart Protection Study, the absolute reduction in coronary events for participants receiving simvastatin versus placebo was similar in those with and without diabetes: 3.2% and 3.0%, respectively (calculated from data in the Heart Protection Study) (1). Therefore, the evidence does not support screening for type 2 diabetes on the basis of lipid status. However, the USPSTF encourages clinicians to perform a global cardiovascular disease risk assessment to determine a person's 10-year cardiovascular disease risk (2) and to screen for type 2 diabetes if knowledge of diabetes status would change management, including the management of hypertension or the use of lipid-lowering agents and aspirin.


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From the Colorado Department of Public Health and Environment, Denver, CO 80246, and Keck School of Medicine, University of Southern California, Los Angeles, CA 90089.

Potential Financial Conflicts of Interest: None disclosed.


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1 .  Collins R, Armitage J, Parish S, Sleigh P, Peto R; Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet . 2003;361:2005-16. [PMID: 12814710].[Medline]

2 .  Health Link, Medical College of Wisconsin. Calculate Your Risk of Coronary Heart Disease. Accessed at http://healthlink.mcw.edu/article/923521437.html on 21 October 2008.


Related articles in Annals:

Clinical Guidelines
Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement
U.S. Preventive Services Task Force
Annals 2008 148: 846-854. [ABSTRACT][SUMMARY][Full Text]  

Letters
Do Lipid-Lowering Agents Provide a Greater Reduction in Cardiovascular Events among Patients with Diabetes?
Anil K. Gollapudi
Annals 2008 149: 841. [Full Text]  




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